Patient Forms & Financial Policy

We encourage you to fill out these forms prior to your appointment to help us expedite the check-in process. In addition please read our financial policy.


We have posted our Patient Information Form and Patient History Form for your convenience. Filling these out in advance will greatly expedite the check in process for your visit with Newton-Wellesley Eye Associates. We ask that you open, print, fill out, and remember to bring the forms with you to your visit.

If your child is a minor and is coming to the office without a legal guardian, a consent form must be signed in order for your child to have an eye exam and receive treatment. Please send in the Guardian Consent Form with your child.

Please click the links below and print the PDF file that opens.

Patient Information Form – Required

Patient History Form – Required

Parent/Guardian Consent for Exam & Treatment
Only If Minor not accompanied by Parent/Guardian

Notice of Privacy Practices

Medical Records Request Form and Instructions

Below is our financial policy. Please read prior to your appointment.

Financial Policy

Financial Responsibility – Required